Pharmacy News and Views

Transcription

1 Maryland Pharmacy Program Pharmacy News and Views Volume 2, Number 1 March 2005 Drug List (PDL): The Second Year The Department of Health and Mental Hygiene's Pharmacy and Therapeutics (P & T) Committee continues to review therapeutic drug classes previously included on the PDL during See page 6 of this newsletter for a list of the drug classes where changes to the preferred status of individual drugs were made at the December 2, 2004 P&T Committee meeting. The complete updated Maryland Drug List and additional information can be viewed online at: Department of Health and Mental Hygiene The PDL program is projected to save more than $31 million annually from supplemental rebates and shifts in market share of preferred drugs. The Maryland Pharmacy Program wishes to thank all pharmacy providers for their cooperation in making this Program a success. Full consideration for the recipient continues to be our top priority. The prescriber and pharmacist are encouraged to review the available options for drug therapy within the PDL. ecipients having problems obtaining prescribed medications may call the Maryland Pharmacy Access Hotline at If you (the pharmacy) have any questions, contact the Department at Maryland Pharmacy Program Provider Advisory In an effort to give timely notice to the pharmacy community concerning important pharmacy topics, the Department of Health and Mental Hygiene's (DHMH) Maryland Pharmacy Program (MPP) has developed the Maryland Pharmacy Program Advisory. To expedite information timely to the pharmacy and prescriber communities, an network has been established which incorporates the lists of the Maryland Pharmacists Association, Maryland Pharmaceutical Society, EPIC, CAE, Long Term Care Pharmacy News and Views is now on the Web A copy of this newsletter and the previous editions of the Pharmacy News and Views newsletter can now be found on the HealthChoice Managed Care Organization website at (continued) Consultants, headquarters of all chain drugstores and prescriber associations and organizations. It is our hope that the information is disseminated to all interested parties. If you have not received the Provider Advisory via through any of the previously noted parties, please contact the MPP representative at to submit the address of a pharmacy organization you may belong to so that we may add it to our network list. Provider Advisories can also be viewed on line at mma/mpap/provadv.html. Contents Drug List Maryland Pharmacy Program Provider Advisory MD Pharmacy Program Website FDA evises Warning for Antidepressant Use in Children Dose Optimization for Atypical Antipsychotic Agents Forms Added to MD Pharmacy Website.. PMAC/IDC Tables Available Quantity Limitations for Anti-Migraine Agents Brand Necessary Medical Prescriptions.. etrospective Drug Utilization eview Duplication of Atypical Antipsychotic Agents. Drug List Updates Contact Information Appropriate Use of Palladone Upcoming Continuing Education Program.. STATE OF MAYLAND DHMH Maryland Department of Health and Mental Hygiene, Office of Operations, Eligibility and Pharmacy 1

2 Maryland Pharmacy Program Website The Maryland Pharmacy Program (MPP) has updated their website over the past several months. The MPP invites you to explore the website, which may serve as a useful resource in your practice. The website contains information on several topics such as: Eligibility requirements for the Maryland Pharmacy Assistance Program Eligibility requirements for the Maryland Pharmacy Discount Program Patient brochures in English and Spanish Applications for the Maryland Pharmacy Assistance Program and Maryland Pharmacy Discount Program Drug List Mental Health Drug Formulary Pharmacy Program Forms Maximum Allowable Cost and Interchangeable Drug Cost tables Provider Advisories and Newsletters Hotline telephone numbers Other websites that may also be useful include the following: First Health Corporation - claims processing, coordinated prospective drug utilization review and prior authorization. Health Information Designs retrospective drug utilization review, pharmacy provider newsletter and HealthChoice managed care organization formulary review. mdmahealthchoicerx.com Provider Synergies manages the preferred drug list. FDA evises Warning for Antidepressant Use in Children The Food and Drug Administration has revised the black box warning included on the labeling of SSI antidepresants. The earlier warning noted that SSIs could cause suicidal actions among children and teens. The revised warning says that these drugs may increase the risk of suicide thinking and behavior based on an evaluation of short-term clinical studies of adolescents and children with depression and other psychiatric disorders. Patients should be cautioned not to stop therapy with these agents unless directed to do so by their prescriber. The risk of not treating depression could lead to negative outcomes for patients. The actual warning can be viewed at antidepressants/default.htm. Dose Optimization for Atypical Antipsychotic Agents The dose optimization criteria and quantity limits for the atypical antipsychotic agents have created some confusion among providers. The limits were implemented to utilize the most cost effective tablet dosage strength for selected atypical antipsychotic agents. For example, the price of two 5mg tablets of Zyprexa or Abilify exceed the price of one 10 mg tablet. Both of these agents are labeled for once daily administration. Therefore, a 2 patient taking two 5mg tablets could be changed to one 10mg tablet with no impact on overall total daily dose. We are simply requesting that prescribers use a more cost effective dosage regimen. Prior authorization for quantities in excess of the limits noted below can be obtained by having the prescriber contact First Health at and submit a prior authorization request. If prior authorization cannot be obtained at the time of dispensing the prescription, please dispense the maximum quantity allowed as listed below and contact the prescriber to obtain prior authorization for a larger quantity before the patient returns for a refill. Please do not allow patients to go without their medications. The limits are noted below. strengths not listed below have no quantity limits. isperdal 2 doses per day/ 68 tablets per month of.25mg;.5mg; 1mg; 2mg Abilify 1 tablet per day/ 34 tablets per month of 5mg; 10mg; 15mg Geodon 2 doses per day/ 68 capsules per month of 20mg; 40mg Zyprexa 1 tablet per day/ 34 per month of 2.5mg; 5mg; 7.5mg and Zyprexa Zydis 5mg Seroquel 4 tablets per day/ 136 per month of 25mg

3 Forms Added to Maryland Pharmacy Program Website All PDL forms, specialty prior authorization forms and pharmacy compounding forms are now available on the website and can be downloaded directly from: All sections of these forms should be completed and signed by the prescriber in order to expedite processing of requests. PEFEED DUG LIST FOMS SPECIALTY FOMS PDL Prior Authorization equest Fax Form PDL Medication Change Fax Form (For pharmacists to use to notify prescribers of preferred alternatives and preauthorization requirements) INVOICES Pharmacy Compounding Clotting Factor and High-Cost Drugs Actiq Pre-Authorization Form Atypical Antipsychotic Agents (For prescribers to request an authorization to override maximum allowable quantities for atypical antipsychotic agents) Growth Hormone (GH) Pre-Authorization equest Form DHMH Medwatch Form (For prescribers to use for attesting to justifications for "Brand Medically Necessary") Instructions for Completing Medwatch Form Nutritional Supplement Pre-Authorization Form Palladone TM Prior Authorization Form Serostim Treatment of AIDS Wasting Syndrome (For prescribers statement of medical necessity for Serostim treatment) Synagis (palivizumab) Pre-Authorization Form Pharmacy Compound Invoice (equired for reimbursement to pharmacies for compounding services) Instructions for Completing Pharmacy Compound Invoice Standard Invoice for All IV Compounds (Form to submit for reimbursement for VI compounding material and services) Instructions for Completing Invoice for All IV Compounds TPN & Hydration Cost Breakdown (Table for computing TPN Costs) Clotting Factor and High-Cost Drug Standard Invoice (equired for reimbursement of clotting factor and charges exceeding $2,500) Clotting Factor and High-Cost Drug Administration ecord (Table for computing clotting factor and other high-cost ingredients) PMAC/IDC Table Available on MPP Website A table listing drugs which are subject to Maximum Allowable Cost (MAC) and Interchangeable Drug Cost (IDC) is now available on the MPP website. The table can be downloaded in excel or text format and is available at This table will be updated as new drugs are added or MAC prices are updated. If you find that the amount allowed is no longer realistic, please contact the department at

4 The Maryland Pharmacy Program will be implementing quantity limits for the anti-migraine agents 5-HT1 agonists, commonly referred to as "Triptans". The purpose of these quantity limitations is to ensure the safe and appropriate use and minimize waste of these very expensive medications. The Triptans are intended to be used as abortive therapy for migraine headaches. The use of these agents should be limited, when possible, to two days per week since more frequent use can lead to rebound headaches. If patients require the use of these agents more than two days per week then they should be evaluated for the addition of some kind of preventative agent such as propranolol. Please refer to the following chart of quantity limitations for the Triptans which will be implemented within the next few weeks. Exceptions to the quantity limits can be obtained with prior authorization. Some override provisions may be considered for any of the following situations: Drug is lost or stolen Vacation/travel supply Prescriber justification for excess quantity request which may include reduced hospitalizations and E visits secondary to headache or migraine disorder. QUANTITY LIMITS FO ANTI-MIGAINE AGENTS (TIPTANS) Brand Name Generic Name Strength Dosage Form How Supplied Limit per Month PEFEED AGENTS * Amerge naratriptan 1 mg 2. Imitrex sumatriptan 2 50 mg 100 mg Maxalt Maxalt MLT Quantity Limitations for Anti-Migraine Agents (Triptans) rizatriptan Injection 2 injections/pkg 2 injections 20 mg 10 mg 10 mg Axert almotriptan Nasal Spray Nasal Spray Orally Disintegrating Orally Disintegrating NON-PEFEED AGENTS * 6 units/pkg 6 units/pkg 2 units of 3/pkg 2 units of 3/pkg 6 units 6 units Frova frovatriptan 2. elpax eletriptan 20 mg 40 mg 12 tablets/pkg 12 tablets/pkg 12 tabs 12 tabs Zomig Zomig ZMT zolmitriptan 2. 3 tablets/pkg Nasal Spray 6 units/pkg 6 units 2. Orally Disintegrating Orally Disintegrating 4 3 tablets/pkg * The preferred status of these agents may change after the next P&T Committee meeting. CITEIA FO APPOVAL: Prior authorization will be needed for any medications prescribed above the indicated quantity limits. Prior authorization will NOT be given for prophylactic therapy of migraine headache. LENGTH OF AUTHOIZATION: - Indefinite; Non- - One Year

5 Brand Medically Necessary Prescription Since November 1, 2004, completion of a DHMH Medwatch form and prior authorization has been required to dispense any brand name drug for which an approved generic is available. The Department has received numerous requests for brand name drugs over the past few months. Many of these requests are for brand name narcotic agents. The vast majority of these requests are being denied since the requests do not demonstrate that there was a true adverse reaction to the generic product or a documented therapeutic failure of the generic. The following are some requests for brand medications which were not approved: Allergic to all generic medications Patient has sensitivity to all generics Needs Brand Generic Paxil causes nausea Generic Demerol does not work Only those requests that can clearly demonstrate an adverse event was precipitated by taking the generic or a documented therapeutic failure will be approved. Adverse events include those that would not be expected to occur while taking the brand, such as an allergy or reaction to a tablet dye or inactive ingredient that was unique to the generic and not included in the brand name formulation. Therapeutic failures must be clearly and completely documented by the prescriber. Please discourage recipients and prescribers from submitting request for multi-source brand name drugs without valid reasons. Copies of DHMH Medwatch forms can be found at md.us/mma/mpap/medwatch.htm. DHMH Medwatch forms must be completed by the prescriber and faxed to the Maryland Pharmacy Program at for review. Prescribers must write "Brand Medically Necessary, DHMH Medwatch Form Submitted" on the prescription order. If the authorization for dispensing the brand has been approved by the Maryland Pharmacy Program, the prescription may be filled by entering DAW = 1 in the DAW code indicator field. Any questions regarding prior authorization of multi-source brand name medications should be directed to the Maryland Pharmacy Program at etrospective Drug Utilization eview: Therapeutic Duplication of Atypical Antipsychotic Agents A retrospective drug utilization review, which included a prescriber directed educational intervention program, was performed in September, ecipients were identified who may be receiving two atypical antipsychotic agents concurrently. The use of two concurrent atypical antipsychotic agents is not supported in the medical literature and should only be considered for patients refractory to treatment with single agents at maximum tolerated doses. The use of two atypical agents not only leads to the risk of increased adverse drug reactions, but also dramatically increases the cost of treatment because of the very high cost associated with these agents. An educational intervention letter containing a complete drug history profile for the recipients involved were sent to the recent prescribers of two concurrent atypical antipsychotic agents. The letter was educational and informational in nature. The complete drug history profile was forwarded with the intervention letter so that prescribers could be made aware of prescribing by other providers. A brief treatment algorithm along with information concerning the adverse effects and cost of the atypical agents was also included with the letter and the drug history profile. Prescribers who received an intervention letter were asked to indicate any action they may take in reference to the intervention letter and also to rate the usefulness of the intervention letter and drug history profile. A total of 500 recipients with evidence of duplicate therapy were reviewed and 400 selected for intervention. A response rate from prescribers of 32% was achieved. esponses to the letter intervention program were generally favorable. Approximately one third of the prescriber responses indicated that some positive action had been or would be taken. The information contained in the intervention letters and drug history profiles was rated as extremely useful or useful by 52% of prescribers who responded to that section of the response form. A followup evaluation is planned for second quarter 2005 to evaluate the impact on prescribing of atypical agents in the selected population. 5

6 Maryland Drug List Updates (Drug categories with changes as a result of the December 2, 2004 Pharmacy and Therapeutics Committee Meeting) ANTI-INFECTIVES ANTI-INFECTIVES (cont.) GASTOINTESTINAL Antifungals, Topical ciclopirox lotion (Leprox) clotrimazole (Lotrimin) clotrimazole/betamethasone (Lotrisone) econazole (Spectazole) ketoconazole (Nizoral) nystatin (Mycostatin) nystatin/triamcinolone (Mycolog II) Mentax Naftin Nizoral Shampoo equires Prior Authorization Ertaczo Loprox Shampoo Loprox Topical Penlac Exelderm Oxistat Antivirals acyclovir (Zovirax) amantadine (Symmetrel) ganciclovir (Cytovene) rimantadaine (Flumadine) Tamiflu Valcyte Valtrex equires Prior Authorization elenza Famvir Macrolides/Ketolides erythromycin Biaxin, XL Zithromax equires Prior Authorization Branded erythromycin products Ketek Cephalosporin and elated Agents amoxicillin/clavulanete (Augmentin) cefaclor (Ceclor, CD) cefacroxil (Duricef) cefuroxime (Ceftin) cephalexin (Keflex) Augmentin X Cefzil Spectracef equires Prior Authorization Cedax Lorabid Panixine aniclor Suprax Omnicef CADIOVASCULA Lipotropics, Statins lovastatin (Mevacor) Advicor Altoprev Caduet Crestor Lescol, XL Lipitor Pravachol Vytorin Zocor equires Prior Authorization Pravigard PAC Antiemetics, Oral metoclopramide (eglan) Emend Kytril Marinol Zofran equires Prior Authorization Anzemet ESPIATOY Bronchodilators, Anticholinergics ipratropium neb (Atrovent) Atrovent Combivent Spiriva equires Prior Authorization Duoneb Beta 2 -Agonist Bronchodilators albuterol (Proventil, Ventolin, Ventolin HFA) albuterol HFA (Proventil HFA) metaproterenol (Alupent) terbutaline (Brethine) Maxair Serevent Diskus Xopenex equires Prior Authorization Accuneb Alupent Vospire E Foradil 6

7 Contact Information First Health First Health ProDur Help Desk First Health Technical Help Desk First Health PDL PA Phone First Health PDL PA Fax Managed Care Organizations Pharmacy Benefits Manager or MCO Contact AMEIGOUP Corporation Maryland Physicians Care Diamond Plan for Coventry Health Care Priority Partners Helix Family Choice United HealthCare Jai Medical Systems, Inc HealthChoice (MCO) Inquiries/Complaints Provider Hotline ecipient Hotline Eligibility Verification System (EVS) (Balto Metro) or (Available 24 hours a day / 7 days a week) Main Department Numbers Department of Health and Mental Hygiene 877-4MD-DHMH Division of Pharmacy Services 877-4MD-DHMH, x71455, or Division of Eligibility Services (Pharmacy Only) or Pharmacy/Nutritional Preauthorization Line Option 3 or Growth Hormone/Synagis Preauthorization Line Option 3 or Pharmacy Access Hotline for recipients Option 3 or Miscellaneous Numbers AIDS Administration Md. AIDS Drug Assistance Program Dental, Audiology and Vision Medicaid, Mental Health Department of Veterans Affairs Paid Claim Status DME/DMS Pharmacy Assistance Eligibility HealthChoice Enrollee Action Line Pharmacy Assistance Policy Free-Standing Clinics Physician Services First Call for Help Provider Enrollment Hospital Services Provider elations ext 5503 Kidney Disease Program Transportation MED Bank of Maryland This number is for physicians only. Newsletter Website and Contact Information DHMH Website HealthChoice Website HealthChoice MCO Formulary Website Maryland Pharmacy Program First Health Website Provider Synergies Website For comments to help improve this newsletter please contact Health Information Designs, Inc. at or toll free , or to mdmahealthchoicerx@hidinc.com 7

8 Pharmacy News and Views Maryland Department of Health and Mental Hygiene Office of Operations, Eligibility and Pharmacy PESOTED STANDAD U.S.POSTAGE PAID BELIN, MD PEMIT NO. 17 Maryland Pharmacy Program 201 West Preston St., 4th Floor Baltimore, Maryland obert L. Ehrlich, Jr., Governor Michael S. Steele, Lt. Governor S. Anthony McCann, Secretary, DHMH Jeffrey Gruel, Editor STAFF: Phil Cogan,.Ph Eva Carey-Brown Joseph Paradis, PharmD, of Health Information Designs, Inc. Appropriate Use of Palladone (long acting hydromorpone) A new long acting once a day formulation of hydromorphone is now available. Palladone (hydromorphone HCl extendedrelease) capsules are available in 12mg, 16mg, 24mg and 32mg strengths. Palladone is only indicated for the management of persistent, moderate to severe pain in patients requiring continuous, around-the-clock analgesia with a high potency opioid for an extended period of time (weeks to months) or longer. Treatment with Palladone should only be initiated in patients for the replacement of other opioid therapy, who have demonstrated opioid tolerance, and who require a minimum total daily dose of opiate medication equivalent to 12mg of oral hydromorphone. Palladone should be administered only once every 24 hours. Appropriate patients for treatment with Palladone include patients who require high doses of potent opioids on an around-the-clock basis for an extended period of time to improve pain control and patients who have difficulty attaining adequate analgesia with immediaterelease opioid formulations. Palladone is contraindicated for use on an as needed basis (i.e., prn). Palladone should never be used as the first opioid product prescribed for a patient, or in patients who require opioid analgesia for a short period of time. Use of Palladone in non-opioid-tolerant patients may lead to fatal respiratory depression. Palladone capsules are to be swallowed whole and are not to be broken, chewed, opened, dissolved or crushed. Taking broken, chewed, dissolved, or crushed Palladone capsules or its contents can lead to the rapid release and absorption of a potentially fatal dose of hydromorphone. Due to the high doses of hydromorphone contained in Palladone capsules, Palladone has a 8 very high potential for misuse and abuse. The Maryland Pharmacy Program is developing prior authorization criteria for the use of the drug. Prior Authorization forms are available on the website at mma/mpap/forms.htm. Upcoming Continuing Education Program On March 20, 2005 from 8 a.m. to 12 noon at the Holiday Inn Select, Timonium, MD, there will be a continuing education program entitled, Update for Pharmacists on HIV/AIDS. Three ACPE CE credits will be awarded for attendance. The speaker is Dr. Jeffery Levy. There will also be a presentation from MADAP. The price is $40 which includes a full buffet breakfast from 8 to 9 a.m. For information or reservations call Stanley Karmiol at All Program information and updates featured in this issue of Pharmacy News and Views are the best information available at the time of printing. Any updates that became effective after the date of printing will be included in the next issue of our newsletter.